Gaceta sanitaria最新文献

英文中文

Cost-effectiveness of direct oral anticoagulants in non-valvular atrial fibrillation.

Gaceta sanitaria

Pub Date : 2025-02-18 DOI: 10.1016/j.gaceta.2025.102451

Inigo Gorostiza, Amaia Bilbao-Gonzalez, Javier Mar

Objective: There is evidence on the efficiency of new direct oral anticoagulants (DOAC), mostly based on experimental efficacy data, but there is also a need to assess their cost-effectiveness in routine clinical practice using patient-level data. We designed a retrospective cohort study to assess the cost-effectiveness of DOAC compared to acenocoumarol in patients with non-valvular atrial fibrillation (NVAF) with a follow-up of up to 7 years.

Method: Basque Health Service-registered patients who started oral anticoagulant treatment between 2013 and 2016 were included in the study and followed up until the end of 2019. Data were extracted from an electronic medical record management system. Effectiveness was expressed in terms of life years gained and adjusted for health-related quality of life (i.e., quality-adjusted life years [QALY]). Propensity score techniques were used to adjust the estimates for differences between groups in baseline characteristics.

Results: A total of 10,843 new users of oral anticoagulants with a mean follow-up of 4.1 years were included. The incremental cost-effectiveness ratio of DOAC compared to acenocoumarol ranged from €1,732 to €2,556/QALY, while the incremental net benefit for different willingness-to-pay thresholds was only negative for values below €3,000/QALY.

Conclusions: Based on the analysis of data from clinical practice and the similarity of results using several different techniques to adjust for bias associated with observational studies, we conclude that DOAC would be an efficient alternative for the treatment of patients with NVAF.

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引用次数: 0

[Analysis of equity and budgetary sustainability of the pharmaceutical co-payment system in Spain]. [西班牙药品共同支付制度的公平性和预算可持续性分析]。

Gaceta sanitaria

Pub Date : 2024-11-25 DOI: 10.1016/j.gaceta.2024.102427

Jaime Pinilla, Christian González-Martel, Beatriz González López-Valcárcel, Félix Lobo, Jaume Puig-Junoy

Objective: To estimate the impact of a more equitable pharmaceutical co-payment system by eliminating the distinction between active workers and pensioners, using only personal income as an adjustment parameter, defining more detailed income brackets, and introducing protective limits on personal expenditure.

Method: Data from a random sample of 4,505,483 individuals residing in Spain were used, matching pharmaceutical consumption information from the Ministry of Health with economic data from the Tax Agency. Five microsimulation scenarios were designed, modifying co-payment percentages and monthly limits, and the effects on public pharmaceutical spending, the economic burden between patients and the Spanish National Health System, and the redistribution of the burden among patient groups were evaluated. The Kakwani index was used to measure the progressivity of each scenario.

Results: The results show that equalizing active workers and pensioners and introducing more detailed income brackets can increase the progressivity of the co-payment system. In scenarios 2, 3, 4, and 5, the Kakwani index was higher than 0.2, indicating greater vertical equity. Public budgetary costs ranged from 48 million euros to 710.2 million euros. In all scenarios, the user's share of pharmaceutical expenditure decreased, especially for lower-income groups.

Conclusions: A more progressive and equitable pharmaceutical co-payment system is feasible and can better protect low-income individuals without disproportionate budgetary impact. Eliminating the distinction between active workers and pensioners and exempting co-payments for incomes below 6,000 euros can significantly increase the system's equity.

目的：通过取消在职工人和养老金领取者之间的区别、仅使用个人收入作为调整参数、定义更详细的收入等级以及引入个人支出保护限额，估算更公平的医药共付额制度的影响：方法：使用了居住在西班牙的 4,505,483 人的随机抽样数据，将卫生部提供的药品消费信息与税务局提供的经济数据进行匹配。设计了五种微观模拟方案，修改了共同支付比例和每月限额，并评估了对公共医药支出、患者与西班牙国家卫生系统之间的经济负担以及患者群体之间负担再分配的影响。采用卡瓦尼指数来衡量每种方案的累进性：结果表明，将在职工人和养老金领取者等同起来，并引入更详细的收入等级，可以提高共同支付系统的累进性。在方案 2、3、4 和 5 中，Kakwani 指数高于 0.2，表明纵向公平性更高。公共预算成本从 4800 万欧元到 7.102 亿欧元不等。在所有方案中，用户的医药支出份额都有所下降，尤其是低收入群体：结论：更加渐进和公平的医药共付制度是可行的，可以更好地保护低收入人群，而不会对预算造成过大的影响。取消在职工人和退休人员之间的区别以及免除收入低于 6 000 欧元的人的共付额可以显著提高该制度的公平性。

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